Preparation for Paediatric Anaesthesia Dr Tim Baker Stockholm, Sweden tim@lifesupportfoundation.org SATA Conference, Tanzania, May 2016 Intro Why do we need to prepare for anaesthesia? Which routines should we use? Which checklists should we use? Common fallacies • ”I do not make mistakes” • ”It was not my fault that the patient died” • ”It is somebody else that is responsible for the equipment” • ”I know the laryngoscope works because I used it earlier • ”I am smarter than a piece of paper” If something can go wrong, it has gone wrong Why do we need routines? Anaesthesia • is complicated • can be standardised • is time dependent • can be dangerous • has many people involved Complications might happen fast so be prepared to act! Which routines should we use? Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines Pre-op visit Aims 1. Assess illness severity - prioritisation 2. Find problems early 3. Optimise the patient Improve outcomes Pre-op form that can be used for all patients Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines Check equipment • Checklist for which equipment should ALWAYS be in the operating theatre • Checked that everything is present & working everyday before every case Check equipment • A: Oropharyngeal airway, laryngoscope, suction, Bougie, ETT different sizes • B: Ambu-bag, Masks different sizes, anaesthesia machine, pulse oximetry, paediatric Ambubag • C: cannulae, syringes, giving sets, tilting of operation table Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines Check drugs Adrenaline Atropine Ephedrine Thiopentone Ketamine Suxamethonium Coffee R.L N.S Halothane ….. Named person responsible for emergency box daily / before every case Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines Patient pre-anaesthesia checklist • Allergies? • Fasting? • Expected difficult airway? • Possible complications • Paediatric patient: • Desaturate FAST • Correct size equipment (and one size bigger, one size smaller) • Correct drug doses How to remember CHECK LISTS Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines Participating Hospitals Results er Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines Summary • Be prepared for possible complications • Emergency drugs & equipment always available in the theatre • Same preparations everytime. Use checklists. Standardised preparations prevent disaster when complications arise tim@lifesupportfoundation.org www.lifesupportfoundation.org